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Accident Report Detail

Accident Summary Nr: 125008.015 - Employee sustains concussion and fractures in fall off PIV

Accident Summary Nr: 125008.015 -- Report ID: 0950633 -- Event Date: 10/29/2019
Inspection NrDate OpenedSICNAICSEstablishment Name
1443755.01511/07/2019493120Lineage Logistics Icm, Llc

Abstract: At 12:19 p.m. on October 29, 2019, an employee working for a logistics warehouse was operating a Raymond Model-8410 Double Pallet Jack in an aisle. The employee stated that he did not remember what happened when he found himself on the ground. Coworkers reported that the employee lost control of the PIV and hit the rack. One coworker reported seeing the employee fall to the ground. The employee stated that he was not trained and evaluated on the double pallet jack and told his supervisor that he was not feeling comfortable operating the PIV. He had been trained on the single pallet jack. The employee sustained a concussion and fractured his pelvis and right leg and required hospitalization for approximately two weeks. While in the hospital, he required surgery on his pelvic area and right leg.

Keywords: Blunt force, Blunt force trauma, Concrete Floor, Concussion, Fall, Fall From Elevation, Fall Protection, Fracture, Head, Injury Illness Prevention Program, Lack of Work Procedures, Leg, Lost Control, Material Handling, Motor Vehicle, PIV, Pallet Jack, Pelvis, Powered Industrial Vehicle, Storage Rack, Training, Untrained, Warehouse, Warehouse Aisle

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury
1 1443755.015 50 M Hospitalized injury

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